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Quality Improvement

Provider Administrative Policy

Care Management
Policy Date
May 2008
Revised/November 2008


Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.


Quality Improvement

Our Quality Improvement Projects (QIP) continuously improve the quality of clinical care and services provided to our members from participating health care providers. By working with health care providers, a QIP integrates administrative services and health care delivery to improve the quality of care provided to members through data collection and analysis, member input, interventions to improve performance and other necessary means. QIP activities may include, but are not limited to, disease management, specialty-specific programs and other nationally recognized clinical surveys/projects. We achieve these goals by:

  • Quality of Care and Service Oversight
    • Clinical or service opportunities through data collection and analysis (example: HEDIS Survey)
    • Input from members on potential clinical or service opportunities
    • Oversight of delegated entities
    • Provider medical record review
  • Quality Improvement Projects
    • Collaborate with physicians and representatives about quality, priorities and opportunities for improvement
    • Develop and implement interventions to improve performance
    • Evaluate the effectiveness of the interventions and modify the interventions for continual improvement

Examples of Quality Improvement Projects
During the past few years, QIPs have included controlling hypertension, cholesterol management, improving mammogram screening rates, provider accessibility and availability, and improving comprehensive diabetes care.

See MA PAP102 for contact information

Policy History

Date Action Reason
November 2008 Revised Contact information link
May 2008 Revised Phone number added

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